Provider Demographics
NPI:1609022987
Name:MINOR, JEREMY CHRISTOPHER (LPN)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:CHRISTOPHER
Last Name:MINOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JAMES DORLAND DR
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-6432
Mailing Address - Country:US
Mailing Address - Phone:845-797-6757
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:8 JAMES DORLAND DR
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6432
Practice Address - Country:US
Practice Address - Phone:845-797-6757
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267815-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse